Frequently Asked Questions

Yes. As part of our billing workflow, claims are reviewed for common billing and coding issues before submission. This may include reviewing diagnosis and procedure code combinations, modifiers, payer requirements, and other information that could affect clean claim submission. The practice remains responsible for accurately documenting and entering all services performed.

We review denials to determine the appropriate next step. Depending on the denial, this may include correcting and resubmitting the claim, submitting an appeal when appropriate documentation is available, following up with the payer, or communicating with the practice when additional information or action is required.

Yes. Accounts receivable follow-up is part of our revenue cycle management services. We work outstanding insurance balances, investigate claim status, address denials and processing issues, and take appropriate follow-up action.

When an insurance carrier processes a claim and assigns an amount to patient responsibility, such as a deductible, copay, or coinsurance, the balance can be transferred to the patient account according to the payer's processing and the practice's established workflow.

No. Revolutionary Revenue Management does not mail or electronically send patient statements. Patient statement generation and delivery remain the responsibility of the practice. We can ensure patient responsibility is appropriately reflected on the account based on insurance processing so the practice has the information needed for its patient billing process.

No. We do not perform patient collections or routine patient collection calls. Our role is focused on the insurance revenue cycle. If the practice needs clarification regarding why a balance was assigned to the patient, we can review the insurance processing and provide information to the practice.

Patient communication remains with the practice. Because the practice maintains the direct provider-patient relationship, we do not routinely communicate with patients regarding balances or billing disputes. We are available to help the practice understand insurance processing so its staff can accurately answer patient questions.

The practice is responsible for documenting and entering all services performed. We review the billing information provided to us, but we cannot know that a service occurred if it was never documented or entered. If a missed service is later identified, we can assist with submitting a corrected claim when appropriate.

No. Payment decisions are made by the insurance carrier and are subject to the patient's coverage, payer policies, medical necessity requirements, timely filing limits, provider participation, documentation, and other factors. Our responsibility is to manage the billing and follow-up process accurately and diligently.

No. Contracted fee schedules are agreements between the practice and the insurance carrier and may not always be available to us. We post and review payments based on the payer's remittance and can investigate unusual processing or payment discrepancies when identified.

No. Revolutionary Revenue Management is not a clearinghouse. If electronic claim submission requires a clearinghouse, the practice will maintain its clearinghouse account and provide the access necessary for us to perform billing services.

During onboarding, the practice provides the appropriate access to its practice management system, clearinghouse, and payer portals as needed. This allows our team to retrieve and review electronic remittance information and perform billing functions.

The practice should provide the document to us through the agreed secure workflow so we can review it and take any necessary billing action.

Eligibility and benefits requests should be available at least two business days before the patient's appointment whenever possible. This gives our team adequate time to obtain and document benefit information.

No. Eligibility and benefit information is based on the information available from the payer at the time verification is completed. Benefits are not a guarantee of payment. Final coverage and patient responsibility are determined by the insurance carrier when the claim is processed.

When deductible information is available from the payer, we document the deductible and remaining deductible information as part of the applicable medical benefit verification.

Unless specifically included in the client's service agreement, obtaining referrals remains the responsibility of the practice. If our verification identifies that a referral may be required, we can notify the practice.

Our standard eligibility workflow requires advance notice. Appointments added within the agreed verification window may remain the responsibility of the practice unless other arrangements have been established.

Credentialing timelines vary significantly by payer. Insurance carriers control application processing times, and some applications may take several months. Revolutionary Revenue Management cannot guarantee a payer's approval date or participation effective date.

No. We prepare, submit, and follow up on credentialing applications, but participation decisions are made solely by the insurance carrier. Network availability, geographic restrictions, provider type, and payer requirements may affect approval.

Credentialing is the process through which a payer reviews a provider's professional qualifications and information. Contracting establishes the provider or practice's participation agreement with the payer, including network status and reimbursement terms. Completing credentialing does not always mean that a provider is automatically considered in-network.

Credentialing requires accurate and current provider information. Access to systems such as CAQH and applicable payer portals allows us to update information, submit applications, complete attestations when authorized, and monitor credentialing activity.

Please forward credentialing-related correspondence to us as soon as possible. Payers sometimes send requests, notices, or documentation directly to the provider or practice. Delays in forwarding these communications can delay an application or require additional follow-up.

No. Contract and reimbursement negotiations remain the responsibility of the practice unless specifically included in a separate written agreement.

Yes. Revolutionary Revenue Management works within the practice's existing systems whenever possible. The practice retains ownership and access to its patient, billing, and financial information.

Yes. The exact access required depends on the services selected. We will identify required systems and access during onboarding.

No. Successful revenue cycle management is a partnership. The practice remains responsible for accurate clinical documentation, entering all services performed, obtaining required patient information and documentation, responding to requests from our team, and completing office-specific responsibilities that are outside the scope of the service agreement.

Yes. Revolutionary Revenue Management specializes in revenue cycle services for optometry and eye care practices, including medical and vision plan billing workflows.

No. Our percentage-based fee is calculated only on insurance payments received and posted. We do not charge any additional fees or percentage on VSP or EyeMed lab fees.